Osteoarthritis (OA) is one of the common orthopaedic diseases in the middle-aged and elderly population, which has a serious impact on the quality of life of patients. The etiological and pathological mechanisms of OA are still unclear, and there is currently no effective preventive and curative measure, so in-depth study of the pathogenesis of osteoarthritis is of great significance. Primary cilia are microtubule-based organelles that play important roles in mechanosensation, mechanotransduction, polarity maintenance, and cellular behaviour during organ development and pathological changes. The hedgehog pathway, as a highly conserved signaling pathway for cellular activities, plays an important role in regulating the formation and development of the skeleton of tissues and organs, as well as in disease processes. In recent years, with the further development of precision medicine and extensive research in cell and molecular biology, it has been found that primary cilia mediate the hedgehog signaling pathway, which can affect the function and degeneration of chondrocytes. The relationship between primary cilia and hedgehog signaling pathway and OA is now reviewed, with the aim of providing precise targets and new ideas for the clinical treatment of articular cartilage injury and OA.